As we continue to navigate the COVID-19 pandemic, the mental health needs of kids and adults continue to rise. Yet, many of these needs remain unmet. Staffing shortages, stigma, and fragmentation of care are just a few of the roadblocks for patients and their families.
The current landscape seems bleak, but the path forward is clear: We must integrate mental health services into primary care settings, as I have written about previously. However, my primary focus here is the critical role of payers, including health plans and self-funded employers and union trusts, to help primary care physicians meet the growing and diverse needs of their patients.
Where Do Primary Care and Mental Health Care Intersect?
Family physicians and their primary care colleagues play a critical role in identifying mental health conditions, ensuring equitable access to mental health care, and reducing the stigma of mental illness.
Almost a third of the care for serious mental illness and a quarter of prescriptions for serious mental illness take place in a primary care setting. Additionally, primary care physicians handled nearly 40% of all visits for depression or anxiety and prescribed half of all antidepressants and anti-anxiety medications pre-pandemic.
Currently, access to comprehensive behavioral health services are unevenly distributed throughout the U.S., and shortages of behavioral health clinicians mean that roughly two-thirds of primary care doctors are often unable to find additional outpatient mental health services to help provide timely treatment.
Where Do Payers Fit In?
We, as primary care doctors, can’t do this alone. As a family physician, I know there are several ways doctors, payers, and purchasers can work together to address the country’s mental health crisis.
The first is that patients would significantly benefit from the integration of behavioral health into primary care. This integration exists along a spectrum ranging from consistent coordination of referrals and exchange of information to co-locating behavioral health services within the primary care practice. We appreciate payers who have already implemented strategies to provide financial support to cover costs and technical assistance that support the integration of behavioral health in primary care teams. I encourage more payers to follow suit.
Others have established comprehensive primary care transformation programs that solidify primary care as central to high-quality, cost-efficient care delivery, including mental health. These payers financially support integration of behavioral and physical health in primary care under multiple models — co-location, psychologist-driven integrated care, and the collaborative care model which provides efficient psychiatric consults when needed — all of which can improve access to mental health and substance use disorder treatment in primary care offices. We applaud the payers who have proven to be strong allies in supporting what works best in practice for patients, as well as for primary care physicians and their care teams. However, we need this behavior from more than a subset of payers — we need all insurers and other payers to take this step.
Additionally, I’ve seen firsthand the positive results when payers eliminate unnecessary barriers to needed care by supporting differentiated co-pays for primary care, waiving co-pays and co-insurance for mental health needs, and implementing an expanded definition of preventive care to allow patients with high-deductible health plans to access mental health services before their deductible limit has been met. Provisions such as this help patients gain affordable access to mental health services before they are in crisis.
It’s more important than ever for primary care practices and payers to work together to eliminate barriers to mental health care for patients and proactively support primary care’s ability to address patients’ physical and mental health concerns. The American Academy of Family Physicians is actively working with other medical societies and payers to accelerate progress. In a rapidly changing landscape, this much I know to be true: All physicians, clinicians, and payers should strive to bring our fractured healthcare system back to a team-based model that places the patient front and center.
Sterling N. Ransone, Jr., MD, is a family physician and president of the American Academy of Family Physicians, which represents more than 125,000 physicians and medical students nationwide and is the largest medical society devoted solely to primary care.
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